HomeMy WebLinkAboutBLDG-19-000709 c
1: ,. MASSACHUSETTS UNIFORM APPLICATION FOR A PERMIT TO PERFORM GAS FITTING WORK
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3 = CITY YARMOUTH MA DATE 7-30/8 I PERMff# /Pier—/9—Ooo')O//
JOBSITE ADDRESS I 7 /7�e/mBinaj Dr'YLIOWNER'SNAME Ity01in Van tip eAe•eL-
AG OWNER ADDRESS , TEy 6107-W( ?-Fagg/FAX
TYPE OR OCCUPANCY TYPE COMMERCIAL EDUCATIONAL❑ RESIDENTIAL[
PRINT
CLEARLY NEW:[ERENOVATION:❑ REPLACEMENT:0 PLANS SUBMIT I LU: YES 0 NO2--
APPLIANCES 7 FLOORS—' BSM 1 2 3 4 5 6 7 8 9 10 11 12 '13 14
BOILER
I i , b i r
BOOSTER
CONVERSION BURNER i11111 Me
COOK STOVE I I
DIRECT VENTHEATER / 1111:
DRYER tl
FIREPLACE
FRYOLATOR
FURNACE
GENERATOR
GRILLE
INFRARED HEATER
LABORATORY COCKS
MAKEUP AIR UNIT 1
OVEN i I. . ..
POOL HEATER
ROOM!SPACE HEATER I ROOF TOP UNIT i i ITESTUNIT HEATER C 'UNVENTED ROOM HEATERRe
WATER HEATERiOTHER ,,
Ii I , I
INSURANCE COVERAGE
I have a current liability insurance policy or its substantial equivalent which meets the requirements of MOL Ch.142 YES 0 NO 0
I IF YOU CHECKED YES,PLEASE INDICATE THE TYPE OF COVERAGE BY CHECKING THE APPROPRIATE BOX BELOW
LIABILITY INSURANCE POLICY a OTHER TYPE INDEMNITY 0 BOND 0
OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the
Massachusetts General Laws,and that my signature on this permit application waives this requirement
CHECK ONE ONLY: OWNER 0 AGENT 0
SIGNATURE OF OWNER OR AGENT
I hereby certify that all of the details and information 1 have submitted or entered regarding this application are true and accurate to the •‘.40. knowledge
and that all plumbing work and installations performed under the permit issued bar this applicabon will be Si '-. a8•. i- . of the
Massachusetts State Plumbing Code and Chapter 142 of the General Laws.
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, PLUMBER-GASFITTER NAME(KEVIN LAMOUREUX LICENSE# 15383 ;COT TU.
MP EJ MGF❑ JP 0 JGF❑ LPG(❑ CORPORATION D# PARTNERSHIP D# LLC❑#
COMPANY NAME:KEVIN LAMOUREUX PLUMBING&HEATING ADDRESS 61 JOBYS LANE 1
CITY OSTERVILLE STATE n ZIP ir"'..si. TEL 508-420.2068
FAX 508-420-7992 ' CELL 508-292-5085 EMAIL lamoureuxplumbing@verizon.net
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HOUGH GAS INSPgCTION NOTES THIS PAVE FOR INSPECTOR USE ONLY FINAL INSPECTION NOTES
Yes No
THIS APPLICATION SERVES AS THE PERMIT 0 ❑ r`. ,
PEE: $ PERMIT$1_, I
PLAN pEVIEW NOTES